INDIAN INFORMATION SERVICE GROUP �A� & �B�

							         INDIAN INFORMATION SERVICE GROUP ‘A’ & ‘B’
           Proforma for Complete Executive Record Sheet
                                                                 Affix
                                                               Recent
                                                             Passport size
                                                             Photograph
1.    Personal Information:

Full Name (IN    :
CAPITAL
LETTER) as
per record
Sex              :      Female                     Male
Date of Birth    :

Birth Details    :    Place          District             State



Grade           :
(tick which is          Group ‘A’                  Group ‘B’
applicable)
IRLA No.        :
(only for Group
‘A’ officers

Present Grade :        HG            SG           SAG      JAG(NFSG)
(tick which is
applicable)           JAG            STS          JTS       Group ’B’
Present Posting :

Post held        :
Religion         :
Category (tick   :
which is               SC           ST      OBC            GEN.
applicable)
Whether          :
belongs to
minority
          INDIAN INFORMATION SERVICE GROUP ‘A’ & ‘B’
            Proforma for Complete Executive Record Sheet

Physically
Handicap
Status
Category of PH       OH   VH     HH/HI
Home town        :
State            :
Permanent        :                  City        St Pincode
Address                                         ate
                                                /
                                                UT


Present          :                  City     State/   Pincode
Address                                      UT


                                    Phone    Mobile   e-Mail
                                    (Resi)


CSE/DR Year      :
Source of        :
Recruitment

Date of Joining :
in IIS Cadre
         INDIAN INFORMATION SERVICE GROUP ‘A’ & ‘B’
           Proforma for Complete Executive Record Sheet

2.   FAMILY DETAILS

Marital Status            :         Married      Unmarried
If Married, Name of       :
spouse
Details of the Children   :   Sl.                         Date of
                                          Name    Sex
                              No.                          Birth




Whether Spouse working : Yes / No
If Yes;
Department/organization : Government / Private
Office Address          :
(With telephone No. and
e-Mail ID)
         INDIAN INFORMATION SERVICE GROUP ‘A’ & ‘B’
           Proforma for Complete Executive Record Sheet


3.   EDUCATIONAL QUALIFICATION

Qualification Disciplin   Specializatio   Year of   Institution   Place
(attach the   e           n               passin    /Universit    /count
copy of                                   g         y             y
certificates)
         INDIAN INFORMATION SERVICE GROUP ‘A’ & ‘B’
           Proforma for Complete Executive Record Sheet


4.   Posting Profile

Grade Media Designation Cadre/Deputation Station/City From To
        INDIAN INFORMATION SERVICE GROUP ‘A’ & ‘B’
          Proforma for Complete Executive Record Sheet


5.   Languages

Mother Tongue        :
Details of languages 5(a) Indian Languages
known
                     1.                Read   Write      speak

                   2.

                   3.

                   4.

                   5(b) Foreign Language
                   1.

                   2.

                   3.

                   4.
         INDIAN INFORMATION SERVICE GROUP ‘A’ & ‘B’
           Proforma for Complete Executive Record Sheet


6.   Training Details

6(a). Foreign Training
Course       Name of the Place/Country From date  To date
title        Institution/              dd/mm/yyyy dd/mm/yyyy
             organization




6(b). Domestic Training
Training     Course title Place/Country From date  To date
Course                                  dd/mm/yyyy dd/mm/yyyy
name
           INDIAN INFORMATION SERVICE GROUP ‘A’ & ‘B’
             Proforma for Complete Executive Record Sheet

7.     Foreign Visits:

Year                     Place Visited        Official / Private




8.     STUDY LEAVE

Purpose            Institution       From date      To date
                                     dd/mm/yyyy     dd/mm/yyyy
         INDIAN INFORMATION SERVICE GROUP ‘A’ & ‘B’
           Proforma for Complete Executive Record Sheet

9.   Details of Disciplinary Proceedings if any

Date & Details of      Date of IO &      Date of      Date & Penalty
Charge Sheet           PO                Enquiry      imposed
                                         Report




10. Details of Criminal Proceedings if any

Date of preliminary   Details of the   Date &         Date & Punishment
investigation         report           Details of     Order Passed by
started by CBI/       submitted by     Charge         Court
Lokayuktha etc.       CBI/             Sheet filed
                      Lokayuktha       in the Court
                      etc.
         INDIAN INFORMATION SERVICE GROUP ‘A’ & ‘B’
           Proforma for Complete Executive Record Sheet

11. Details of Court Cases filed.

OA/CP/WP/SLP Name of the            Details         Present
No.          Court/Bench                            Status




12. Details of Annual Immovable Property Return for the last 5
years.

Year                   Details

2012-2011

2011-2010

2010-2009

2009-2008

2008-2007
        INDIAN INFORMATION SERVICE GROUP ‘A’ & ‘B’
          Proforma for Complete Executive Record Sheet

12. Status of Annual Performance Appraisal Report for the last 5
years.

Year                   Status

2012-2011

2011-2010

2010-2009

2009-2008

2008-2007